Brian A Mc Ardle1, Ross A Davies1, Li Chen1, Gary R Small1, Terrence D Ruddy1, Girish Dwivedi1, Yeung Yam1, Haissam Haddad1, Lisa M Mielniczuk1, Ellamae Stadnick1, Renee Hessian1, Ann Guo1, Rob S Beanlands1, Robert A deKemp1, Benjamin J W Chow2. 1. From the Division of Cardiology, Department of Medicine (B.A.M.A., R.A.D., G.R.S., T.D.R., G.D., Y.Y., H.H., L.M.M., E.S., R.H., R.S.B., B.J.W.C.), National Cardiac PET Center (B.A.M.A., R.A.D., T.D.R., R.H., A.G., R.S.B., R.A.d., B.J.W.C.), and Division of Cardiology, Department of Medicine, Cardiovascular Research Methods Center (L.C.), University of Ottawa Heart Institute. Ottawa, Canada. 2. From the Division of Cardiology, Department of Medicine (B.A.M.A., R.A.D., G.R.S., T.D.R., G.D., Y.Y., H.H., L.M.M., E.S., R.H., R.S.B., B.J.W.C.), National Cardiac PET Center (B.A.M.A., R.A.D., T.D.R., R.H., A.G., R.S.B., R.A.d., B.J.W.C.), and Division of Cardiology, Department of Medicine, Cardiovascular Research Methods Center (L.C.), University of Ottawa Heart Institute. Ottawa, Canada. bchow@ottawaheart.ca.
Abstract
BACKGROUND: Cardiac allograft vasculopathy is a key prognostic determinant after heart transplant. Detection and risk stratification of patients with cardiac allograft vasculopathy are problematic. Positron emission tomography using rubidium-82 allows quantification of absolute myocardial blood flow and may have utility for risk stratification in this population. METHODS AND RESULTS: Patients with a history of heart transplant undergoing dipyridamole rubidium-82 positron emission tomography were prospectively enrolled. Myocardial perfusion and left ventricular ejection fraction were recorded. Absolute flow quantification at rest and after dipyridamole stress as well as the ratio of mean global flow at stress and at rest, termed myocardial flow reserve, were calculated. Patients were followed for all-cause death, acute coronary syndrome, and heart failure hospitalization. A total of 140 patients (81% men; median age, 62 years; median follow-up, 18.2 months) were included. There were 14 events during follow-up (9 deaths, 1 acute coronary syndrome, and 4 heart failure admissions). In addition to baseline clinical variables (estimated glomerular filtration rate, previously documented cardiac allograft vasculopathy), relative perfusion defects, mean myocardial flow reserve, and mean stress myocardial blood flow were significant predictors of adverse outcome. CONCLUSIONS: Abnormalities on rubidium-82 positron emission tomography were predictors of adverse events in heart transplant patients. Larger prospective studies are required to confirm these findings.
BACKGROUND:Cardiac allograft vasculopathy is a key prognostic determinant after heart transplant. Detection and risk stratification of patients with cardiac allograft vasculopathy are problematic. Positron emission tomography using rubidium-82 allows quantification of absolute myocardial blood flow and may have utility for risk stratification in this population. METHODS AND RESULTS:Patients with a history of heart transplant undergoing dipyridamole rubidium-82 positron emission tomography were prospectively enrolled. Myocardial perfusion and left ventricular ejection fraction were recorded. Absolute flow quantification at rest and after dipyridamole stress as well as the ratio of mean global flow at stress and at rest, termed myocardial flow reserve, were calculated. Patients were followed for all-cause death, acute coronary syndrome, and heart failure hospitalization. A total of 140 patients (81% men; median age, 62 years; median follow-up, 18.2 months) were included. There were 14 events during follow-up (9 deaths, 1 acute coronary syndrome, and 4 heart failure admissions). In addition to baseline clinical variables (estimated glomerular filtration rate, previously documented cardiac allograft vasculopathy), relative perfusion defects, mean myocardial flow reserve, and mean stress myocardial blood flow were significant predictors of adverse outcome. CONCLUSIONS: Abnormalities on rubidium-82 positron emission tomography were predictors of adverse events in heart transplant patients. Larger prospective studies are required to confirm these findings.
Authors: John J Lazarus; Ashraf Saleh; Michael Ghannam; Keith Aaronson; Monica Colvin; Frank Pagani; Todd Koelling; James R Corbett; Richard L Weinberg; Venkatesh L Murthy; Matthew C Konerman Journal: J Nucl Cardiol Date: 2018-11-27 Impact factor: 5.952